The Short Arm Of Chromosome 4 (Frank Huyler)

I let her sleep it off in the hall stretcher. She was blind drunk, and she stank, her light brown hair coiled on her neck, her blue eyes half-open to the ceiling. She lay still, but every so often something happened: a twisting movement, a jerk on the gurney, one arm flailing into the air. Her lips trembled, and as I passed I could hear her muttering, fast and low, nonsensical.

She wore stained overalls and a bandanna. When the nurse took off her shoes her feet were black, crusted, and smelled so badly that we wrapped them in plastic bags. She lay under the IV fluids, her feet in shining plastic taped neatly at the ankle, and I left her there because she was nothing, really, another drunk on a warm summer night.

Early in the morning a man appeared. He wore a mechanic’s blue shin with “Bill” embroidered on the pocket. His hair was black and smooth, neatly combed, and he smelled of oil and cigarette smoke. He stood by her bed, looking down at her, and as I passed he touched my shoulder. “Excuse me,” he asked, politely. “Can I talk to her doctor?” He gestured to the woman on the gurney.

“I’m her doctor.”

“Can you tell me what’s wrong with her?”

“She’s drunk,” I said. “That’s all.”

He nodded, as if expecting the answer, “I left her because of her drinking. She’s my wife. She has Huntington’s disease.”

With that he stopped me. I looked at her chart again, and there, among the nurses’ notes, barely legible, was written “Hutchinshons Disease?” She had told the triage nurse, or had tried to. “Huntington’s disease?” I said.

I looked at her again, and suddenly it was clear—the twitching mouth, the spasmodic movements of the arms. I remembered the grainy film I had seen in medical school, shot in the 1950s, of patients with neurologic disorders. They were marched out for the camera to perform their dances, led across a room as the voice-over ran.

I had never seen a case of Huntington’s disease, but I knew what it was: a genetic disorder that begins mysteriously in mid-life, progresses to insanity and death within a few years. The short arm of chromosome 4. She was near the end. She was also drunk.

“Can you get her to a room?”

His voice brought me back to the moment.

“Yes, of course,” I mumbled. “Let me talk to the charge nurse.”

The nurse moved her to a cubicle a few minutes later, but it was over an hour before I could get back to them. When I opened the curtain of the room I did not recognize the woman. She wore clean jeans and a T-shirt, new white socks. Her hair was damp and brushed. Someone had bathed her and dressed her, but no one was there.

I bent over to examine her again, and she was the same. No marks, no bruises, just the strong smell of alcohol, the incoherent mumbling, the episodic jerks of the arms. Nothing to be done but leave her until morning, when the social worker would come.

On my way out of the room I saw her husband again. He was coming back down the hall, holding a plastic bag full of reeking overalls and her shoes. A girl stood next to him. She was perhaps seventeen and quite beautiful, with long blond hair and blue eyes, taller than her father.

“This is our daughter,” the man said to me. I looked at the girl. She looked back calmly, neither friendly nor unfriendly.

“Hello,” I said. She nodded, then passed me and entered the cubicle, smelling of soap and faintly of perfume. She pulled the curtain.

They had done it together, father and daughter. They had taken off her clothes and washed her body and hair, in private. I realized that the new clothes must have been her daughter’s, that for a few hours she had been remade into the image of wife and mother. I looked at the man, and he saw the question on my face.

“We don’t know if our daughter has the gene,” he said, looking down the hall. “She doesn’t want to get tested.”

When the girl emerged again I found myself staring at her. She was young or she was old. Her future would go on, or it would stop with her mother, whose muttering flowed out from under the curtain, a continuous low language which she, if the numbers aligned, would learn also.

Discussion questions:

1) How does the author use language to convey dehumanization? Can you think of other examples within medicine where language serves to dehumanize, or at least render the patient as object rather than subject?

2) What does this piece tell us about the (moral) value given to disease(s)? What choices does the author make that betray these judgments? How do these line up with broader social values?